PURPOSE:Options for autologous breast reconstruction in women with insufficient abdominal donor site volume are limited. Most reports focus on bipedicled bilateral abdominal flaps for unilateral breast reconstruction. This is not an option for patients requiring bilateral breast reconstruction. We report a novel approach to obtaining increased volume using bipedicled hemi-abdominal free flaps for each breast in patients undergoing bilateral breast reconstruction. This is the first description of a stacked hemi-abdominal extended perforator (SHAEP) flap for breast reconstruction.METHODS:Twelve SHAEP flaps were performed on 7 patients including 9 DIEP/DCIA, 2 DIEP/SIEA, and 1 SIEA/SCIA flap combinations. Indications included large volume breast reconstruction using only abdominal donor sites in patients with insufficient abdominal tissue when using a single-pedicle. A retrospective review evaluated patient demographics, surgical techniques, operative time and complications. Average follow-up was 129 days (range 23-208 days).RESULTS:All SHAEP flaps were successful. Average hemi-abdominal flap volume was 724g (range 637-813g). There have been no incidences of partial or total flap loss. There were no incidences of hematoma, seroma or infection. Flap volume increased 19-125% compared to MRI estimates.CONCLUSION:The bipedicled SHAEP flap is an excellent option in women requiring significant breast volume in whom there is insufficient abdominal tissue using single pedicled reconstruction. It allows for total autologous breast reconstruction with increased volume, enhanced flap perfusion, acceptable operative time and muscle preservation using a single, hemi-abdominal, conventional donor site. Future studies are needed to evaluate long-term complications as well as the utility of preoperative imaging.